Provider Demographics
NPI:1740303312
Name:FOX VALLEY INTERNAL MEDICINE
Entity type:Organization
Organization Name:FOX VALLEY INTERNAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:BRONGIEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-830-1900
Mailing Address - Street 1:403 W IRVING PARK RD
Mailing Address - Street 2:
Mailing Address - City:STREAMWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60107-2851
Mailing Address - Country:US
Mailing Address - Phone:630-830-1900
Mailing Address - Fax:630-830-1904
Practice Address - Street 1:403 W IRVING PARK RD
Practice Address - Street 2:
Practice Address - City:STREAMWOOD
Practice Address - State:IL
Practice Address - Zip Code:60107-2851
Practice Address - Country:US
Practice Address - Phone:630-830-1900
Practice Address - Fax:630-830-1904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL21609105OtherBLUECROSS BLUESHIELD
IL21609105OtherBLUECROSS BLUESHIELD